Classification and treatment of spontaneous carotid-cavernous sinus fistulas

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  • 1 Departments of Surgery (Neurosurgery), Ophthalmology (Neuro-ophthalmology), and Radiology (Neuroradiology), Emory University School of Medicine, Atlanta, Georgia
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✓ An anatomical-angiographic classification for carotid-cavernous sinus fistulas is introduced and a series of 14 patients with spontaneous carotid-cavernous sinus fistulas is reviewed to illustrate the usefulness of such a classification for patient evaluation and treatment. Fistulas are divided into four types: Type A are direct high-flow shunts between the internal carotid artery and the cavernous sinus; Type B are dural shunts between meningeal branches of the internal carotid artery and the cavernous sinus; Type C are dural shunts between meningeal branches of the external carotid artery and the cavernous sinus; and Type D are dural shunts between meningeal branches of both the internal and external carotid arteries and the cavernous sinus. The anatomy, clinical manifestations, angiographic evaluation, indications for therapy, and therapeutic options for spontaneous carotid-cavernous sinus fistulas are discussed.

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Contributor Notes

Address reprint requests to: Daniel L. Barrow, M.D., Division of Neurosurgery, Emory University Clinic, 1365 Clifton Road N.E., Atlanta, Georgia 30322.
  • 1.

    Aminoff MJ: Vascular anomalies in the intracranial dura mater. Brain 96:601612, 1973 Aminoff MJ: Vascular anomalies in the intracranial dura mater. Brain 96:601–612, 1973

    • Search Google Scholar
    • Export Citation
  • 2.

    Barrow DL, , Fleischer AS, & Hoffman JC: Complications of detachable balloon catheter technique in the treatment of traumatic intracranial arteriovenous fistulas. J Neurosurg 56:396403, 1982 Barrow DL, Fleischer AS, Hoffman JC: Complications of detachable balloon catheter technique in the treatment of traumatic intracranial arteriovenous fistulas. J Neurosurg 56:396–403, 1982

    • Search Google Scholar
    • Export Citation
  • 3.

    Bennett DR, , Van Dyk HJL, & Davis DO: Carotid cavernous sinus fistula closure following angiography. JAMA 224:16371639, 1973 Bennett DR, Van Dyk HJL, Davis DO: Carotid cavernous sinus fistula closure following angiography. JAMA 224:1637–1639, 1973

    • Search Google Scholar
    • Export Citation
  • 4.

    Biglan AW, , Pang D, & Shuckett EP, et al: External carotid-cavernous fistula in an infant. Am J Ophthalmol 91:351356, 1981 Biglan AW, Pang D, Shuckett EP, et al: External carotid-cavernous fistula in an infant. Am J Ophthalmol 91:351–356, 1981

    • Search Google Scholar
    • Export Citation
  • 5.

    Brackett CE Jr: The complications of carotid artery ligation in the neck. J Neurosurg 10:91106, 1953 Brackett CE Jr: The complications of carotid artery ligation in the neck. J Neurosurg 10:91–106, 1953

    • Search Google Scholar
    • Export Citation
  • 6.

    Dandy WE, & Follis RH Jr: On the pathology of carotid-cavernous aneurysms (pulsating exophthalmos). Am J Ophthalmol 24:365385, 1941 Dandy WE, Follis RH Jr: On the pathology of carotid-cavernous aneurysms (pulsating exophthalmos). Am J Ophthalmol 24:365–385, 1941

    • Search Google Scholar
    • Export Citation
  • 7.

    Day AL, & Rhoton AL Jr: Aneurysms and arteriovenous fistulae of the intracavernous carotid artery and its branches, in Youmans JR (ed): Neurological Surgery, ed 2. Philadelphia: WB Saunders, 1982, pp 17641785 Day AL, Rhoton AL Jr: Aneurysms and arteriovenous fistulae of the intracavernous carotid artery and its branches, in Youmans JR (ed): Neurological Surgery, ed 2. Philadelphia: WB Saunders, 1982, pp 1764–1785

    • Search Google Scholar
    • Export Citation
  • 8.

    Debrun G: Treatment of traumatic carotid-cavernous fistula using detachable balloon catheters. AJNR 4:355356, 1983 Debrun G: Treatment of traumatic carotid-cavernous fistula using detachable balloon catheters. AJNR 4:355–356, 1983

    • Search Google Scholar
    • Export Citation
  • 9.

    Debrun G, , Lacour P, & Caron JP, et al: Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions. J Neurosurg 49:635649, 1978 Debrun G, Lacour P, Caron JP, et al: Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions. J Neurosurg 49:635–649, 1978

    • Search Google Scholar
    • Export Citation
  • 10.

    Debrun G, , Lacour P, & Vinuela F, et al: Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 55:678692, 1981 Debrun G, Lacour P, Vinuela F, et al: Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 55:678–692, 1981

    • Search Google Scholar
    • Export Citation
  • 11.

    De Keizer RJW: Spontaneous carotid-cavernous fistulas. Neuro-ophthalmology 2:3546, 1981 De Keizer RJW: Spontaneous carotid-cavernous fistulas. Neuro-ophthalmology 2:35–46, 1981

    • Search Google Scholar
    • Export Citation
  • 12.

    Hamby WB: Carotid-Cavernous Fistula. Springfield, Ill: Charles C Thomas, 1966, pp 910, 13 Hamby WB: Carotid-Cavernous Fistula. Springfield, Ill: Charles C Thomas, 1966, pp 9–10, 13

    • Search Google Scholar
    • Export Citation
  • 13.

    Hardy RW Jr, , Costin JA, & Weinstein M, et al: External carotid cavernous fistula treated by transfemoral embolization. Surg Neurol 9:255256, 1978 Hardy RW Jr, Costin JA, Weinstein M, et al: External carotid cavernous fistula treated by transfemoral embolization. Surg Neurol 9:255–256, 1978

    • Search Google Scholar
    • Export Citation
  • 14.

    Lasjaunias P, , Moret J, & Mink J: The anatomy of the inferolateral trunk (ILT) of the internal carotid artery. Neuroradiology 13:215220, 1977 Lasjaunias P, Moret J, Mink J: The anatomy of the inferolateral trunk (ILT) of the internal carotid artery. Neuroradiology 13:215–220, 1977

    • Search Google Scholar
    • Export Citation
  • 15.

    Lie TA: Congenital Anomalies of the Carotid Arteries, Including the Carotid-Basilar and Carotid-Vertebral Anastomoses. An Angiographic Study and a Review of the Literature. Amsterdam: Excerpta Medica, 1968 Lie TA: Congenital Anomalies of the Carotid Arteries, Including the Carotid-Basilar and Carotid-Vertebral Anastomoses. An Angiographic Study and a Review of the Literature. Amsterdam: Excerpta Medica, 1968

    • Search Google Scholar
    • Export Citation
  • 16.

    Mahaley MS Jr, & Boone SC: External carotid-cavernous fistula treated by arterial embolization. Case report. J Neurosurg 40:110114, 1974 Mahaley MS Jr, Boone SC: External carotid-cavernous fistula treated by arterial embolization. Case report. J Neurosurg 40:110–114, 1974

    • Search Google Scholar
    • Export Citation
  • 17.

    Miller JD, , Jawad K, & Jennett B: Safety of carotid ligation and its role in the management of intracranial aneurysms. J Neurol Neurosurg Psychiatry 40:6472, 1977 Miller JD, Jawad K, Jennett B: Safety of carotid ligation and its role in the management of intracranial aneurysms. J Neurol Neurosurg Psychiatry 40:64–72, 1977

    • Search Google Scholar
    • Export Citation
  • 18.

    Mullan S: Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg 50:131144, 1979 Mullan S: Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg 50:131–144, 1979

    • Search Google Scholar
    • Export Citation
  • 19.

    Newton TH, & Hoyt WF: Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1:7181, 1970 Newton TH, Hoyt WF: Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1:71–81, 1970

    • Search Google Scholar
    • Export Citation
  • 20.

    Obrador S, , Gomez-Bueno J, & Silvela J: Spontaneous carotid-cavernous fistula produced by ruptured aneurysm of the meningohypophyseal branch of the internal carotid artery. Case report. J Neurosurg 40:539543, 1974 Obrador S, Gomez-Bueno J, Silvela J: Spontaneous carotid-cavernous fistula produced by ruptured aneurysm of the meningohypophyseal branch of the internal carotid artery. Case report. J Neurosurg 40:539–543, 1974

    • Search Google Scholar
    • Export Citation
  • 21.

    Odom GL: Ophthalmic involvement in neurological vascular lesions, in Smith JD (ed): Neuro-ophthalmology. Springfield, Ill: Charles C Thomas, 1964, pp 196 Odom GL: Ophthalmic involvement in neurological vascular lesions, in Smith JD (ed): Neuro-ophthalmology. Springfield, Ill: Charles C Thomas, 1964, pp 1–96

    • Search Google Scholar
    • Export Citation
  • 22.

    Odom GL, & Tindall GT: Carotid ligation in the treatment of certain intracranial aneurysms. Clin Neurosurg 15:101116, 1968 Odom GL, Tindall GT: Carotid ligation in the treatment of certain intracranial aneurysms. Clin Neurosurg 15:101–116, 1968

    • Search Google Scholar
    • Export Citation
  • 23.

    Olivecrona H: Ligature of the carotid artery in intracranial aneurysms. Acta Chir Scand 91:353368, 1944 Olivecrona H: Ligature of the carotid artery in intracranial aneurysms. Acta Chir Scand 91:353–368, 1944

    • Search Google Scholar
    • Export Citation
  • 24.

    Osborn AG: Introduction to Cerebral Angiography. Hagerstown, Md: Harper & Row, 1980, p 112 Osborn AG: Introduction to Cerebral Angiography. Hagerstown, Md: Harper & Row, 1980, p 112

    • Search Google Scholar
    • Export Citation
  • 25.

    Parkinson D: Carotid cavernous fistula: direct repair with preservation of the carotid artery. Technical note. J Neurosurg 38:99106, 1973 Parkinson D: Carotid cavernous fistula: direct repair with preservation of the carotid artery. Technical note. J Neurosurg 38:99–106, 1973

    • Search Google Scholar
    • Export Citation
  • 26.

    Parkinson D: Collateral circulation of cavernous carotid artery: anatomy. Can J Surg 7:251268, 1964 Parkinson D: Collateral circulation of cavernous carotid artery: anatomy. Can J Surg 7:251–268, 1964

    • Search Google Scholar
    • Export Citation
  • 27.

    Peeters FLM, & Kroger R: Dural and direct cavernous sinus fistulas. AJR 132:599606, 1979 Peeters FLM, Kroger R: Dural and direct cavernous sinus fistulas. AJR 132:599–606, 1979

    • Search Google Scholar
    • Export Citation
  • 28.

    Pool JL, & Potts DG: Aneurysms and Arteriovenous Anomalies of the Brain: Diagnosis and Treatment. New York: Harper & Row, 1965, p 307 Pool JL, Potts DG: Aneurysms and Arteriovenous Anomalies of the Brain: Diagnosis and Treatment. New York: Harper & Row, 1965, p 307

    • Search Google Scholar
    • Export Citation
  • 29.

    Poppen JL: Specific treatment of intracranial aneurysms. Experiences with 143 surgically treated patients. J Neurosurg 8:75102, 1951 Poppen JL: Specific treatment of intracranial aneurysms. Experiences with 143 surgically treated patients. J Neurosurg 8:75–102, 1951

    • Search Google Scholar
    • Export Citation
  • 30.

    Pugatch RD, & Wolpert SM: Transfemoral embolization of an external carotid-cavernous fistula. Case report. J Neurosurg 42:9497, 1975 Pugatch RD, Wolpert SM: Transfemoral embolization of an external carotid-cavernous fistula. Case report. J Neurosurg 42:94–97, 1975

    • Search Google Scholar
    • Export Citation
  • 31.

    Raskind R, , Johnson N, & Hance D: Carotid cavernous fistula in pregnancy. Angiology 28:671676, 1977 Raskind R, Johnson N, Hance D: Carotid cavernous fistula in pregnancy. Angiology 28:671–676, 1977

    • Search Google Scholar
    • Export Citation
  • 32.

    Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125145, 1974 Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg 41:125–145, 1974

    • Search Google Scholar
    • Export Citation
  • 33.

    Slusher MM, , Lennington BR, & Weaver RG, et al: Ophthalmic findings in dural arteriovenous shunts. Ophthalmology 86:720731, 1979 Slusher MM, Lennington BR, Weaver RG, et al: Ophthalmic findings in dural arteriovenous shunts. Ophthalmology 86:720–731, 1979

    • Search Google Scholar
    • Export Citation
  • 34.

    Taniguchi RM, , Goree JA, & Odom GL: Spontaneous carotid-cavernous shunts presenting diagnostic problems. J Neurosurg 35:384391, 1971 Taniguchi RM, Goree JA, Odom GL: Spontaneous carotid-cavernous shunts presenting diagnostic problems. J Neurosurg 35:384–391, 1971

    • Search Google Scholar
    • Export Citation
  • 35.

    Toya S, , Shiobara R, & Izumi J, et al: Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage. Report of two cases. J Neurosurg 54:252256, 1981 Toya S, Shiobara R, Izumi J, et al: Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage. Report of two cases. J Neurosurg 54:252–256, 1981

    • Search Google Scholar
    • Export Citation
  • 36.

    Viñuela F, , Fox AJ, & Debrun GM, et al: Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 60:976984, 1984 Viñuela F, Fox AJ, Debrun GM, et al: Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 60:976–984, 1984

    • Search Google Scholar
    • Export Citation
  • 37.

    Voigt K, & Sauer M, Dichgans J: Spontaneous occlusion of a bilateral caroticocavernous fistula studied by serial angiography. Neuroradiology 2:207211, 1971 Voigt K, Sauer M, Dichgans J: Spontaneous occlusion of a bilateral caroticocavernous fistula studied by serial angiography. Neuroradiology 2:207–211, 1971

    • Search Google Scholar
    • Export Citation
  • 38.

    Voris HC: Complications of ligation of the internal carotid artery. J Neurosurg 8:119131, 1951 Voris HC: Complications of ligation of the internal carotid artery. J Neurosurg 8:119–131, 1951

    • Search Google Scholar
    • Export Citation
  • 39.

    Walker AE, & Allègre GE: Carotid-cavernous fistulas. Surgery 39:411422, 1956 Walker AE, Allègre GE: Carotid-cavernous fistulas. Surgery 39:411–422, 1956

    • Search Google Scholar
    • Export Citation

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